Medicaid

Medicaid is a state and federal cooperative program, authorized under Title XIX of the Social Security Act and Chapter 32 of the Texas Human Resources Code, that pays for certain medical and health care costs for people who qualify.

Texas pharmacies that want to dispense outpatient prescriptions must be contracted with the Vendor Drug Program prior to providing services to individuals enrolled in either a Medicaid managed care health plan or traditional Medicaid (also known as fee-for-service). The type of Medicaid coverage a person gets depends on where the person lives and what kind of health issues the person has.

The Vendor Drug Program is responsible for outpatient prescriptions for individuals enrolled in traditional Medicaid.

Children's Health Insurance Program 

Children in Texas without health insurance may be able to get low cost or free health coverage from the Children’s Health Insurance Program (CHIP). 

Enrollment as a Medicaid pharmacy provider is a prerequisite for participation in CHIP.  VDP manages the CHIP formulary but all CHIP services, including prescription benefits, are delivered through managed care medical and dental plans.

Children with Special Health Care Needs Services Program 

The Children with Special Health Care Needs (CSHCN) Services Program helps children with special health-care needs and people of any age with cystic fibrosis.  It helps individuals with their medical, dental, and mental health care, prescriptions, case management, travel to health care visits, and insurance premiums.

Enrollment as a Medicaid pharmacy provider is a prerequisite for participation in the CSHCN Services program.

Healthy Texas Women Program 

The Healthy Texas Women (HTW) expands access to women’s health and family planning services to eligible individuals. The HTW program includes family planning services, related preventive health services that are beneficial to reproductive health, and other preventive health services that positively affect maternal health and future pregnancies.

Enrollment as a Medicaid pharmacy provider is a prerequisite for participation in the HTW program.  The HTW program offers services to low-income women who are 15 through 44 years of age.  VDP only reimburses pharmacy providers for the outpatient prescription products on the HTW formulary.  Family planning drugs and supplies are exempt from the three prescriptions-per-month limit for up to a six-month supply.  HTW does not cover emergency birth control.

Kidney Health Care Program 

The Kidney Health Care (KHC) program helps people with end-stage renal disease get their health care services. It helps clients with their dialysis treatments, access surgery, prescriptions, travel to health care visits, and Medicare premiums.  Medicaid eligible clients are not eligible for KHC drug benefits.

Pharmacies must have a fully executed Medicaid contract before being allowed to participate in the KHC program.